Types of Treatments:

External Beam Radiation Therapy

Radiation therapy is a very effective treatment that can kill cancer cells while preserving the function of nearby normal tissues. The treatment consists of a series of visits in which painless beams of high energy x-rays or particles are aimed at tumor deposits while care is taken to minimize dose to the surrounding normal tissues. Radiation therapy may be used either alone or in combination with surgery and/or chemotherapy to cure many cancers or to alleviate the distressing symptoms that are sometimes associated with more advanced cancers.

The decision to use radiation therapy for a particular patient is entrusted to a physician called a radiation oncologist who specializes in the treatment of cancer with a particular emphasis on the use of radiation. A patient is referred by their physicians to this board certified specialist to determine whether radiation therapy is the most appropriate option for that individual. The patient then meets with the radiation oncologist for a consultation at which time the radiation oncologist evaluates many factors, including the type of cancer, the location of the disease, and the patient’s symptoms, to determine if the patient is a suitable candidate for radiation treatments. At this visit, the radiation oncologist explains to the patient the potential benefits and complications of the proposed treatments.

Patients who are accepted for radiation are then scheduled for a CT simulation, the first step in the complex process of planning their radiation treatments. This CT simulation is like a practice treatment in which the radiation oncologist determines the position that the patient will occupy during the treatments, constructs any customized immobilization devices required to help the patient hold still for the therapy, and obtains CT scan images to determine the precise location of the tumor to be targeted and the surrounding normal tissues that need to be shielded from the radiation.

The radiation oncologist uses these CT images to delineate the targets and design the beams that will be used to treat these targets. The physician then consults with specialized board certified physicists and dosimetrists who supervise the complex calculations that must be performed on powerful computers to blend multiple beams coming into the patient from different directions into an individualized, 3-dimensional plan that delivers the prescribed dose of radiation to the intended targets while minimizing dose to the normal tissues. The physicists are also responsible for calibrating the equipment to ensure that radiation is delivered with precision.

Treatments, which typically last less than fifteen minutes each day and are delivered Monday through Friday, are administered by specially trained techologists called radiation therapists. These therapists deliver the treatments designed by the radiation oncologist and calculated by the dosimetry staff using a state-of-the-art dual energy linear accelerator that is capable of delivering even the most sophisticated treatments, including IMRT (Intensity Modulated Radiation Therapy).

As patients proceed through their treatment course, which can last from one to eight weeks depending on the nature of the patient’s disease, they will be seen regularly by both the radiation oncologist and the nursing staff to assess and address any problems that may arise during the therapy. Patients can also consult with the cancer center’s nutritionist or social worker for additional, specialized support.

The entire radiation oncology team is available at all times to provide a full spectrum of support to meet all the needs of the cancer patient. The team also maintains close contact with your referring physician throughout your treatments to provide timely reports on your progress during the weeks of radiation therapy.

Following completion of your therapy, follow up appointments will be scheduled with the radiation oncologist to monitor your response to radiation.

Prone Breast Irradiation

Research has found that positioning some women with breast cancer in the prone—or face down—position when they receive radiation therapy minimizes the risk of damage to the heart, lungs and surrounding structures. Studies also demonstrate that prone breast irradiation results in reduced skin irritation for many women.

Until recently, women with breast cancer could receive this relatively unique treatment option only at a few large academic medical centers, but now women can obtain this treatment much closer to home at the Hunterdon Regional Cancer Center. The Cancer Center has skilled radiation oncologists (ink to physician page on website), physicists and therapists trained in this innovative technique, continuing our tradition of offering patients in our community the full range of advanced cancer care treatment options without the need to travel. “Prone positioning is not for everyone. Women with smaller breasts or cancers close to the chest wall may do better with radiation treatment delivered while laying on their back in the traditional supine position,” says Oren Cahlon, MD a radiation oncologist at Hunterdon Regional Cancer Center. Dr. Cahlon joined HRCC in September 2009 after spending 5 years at Memorial Sloan Kettering Cancer Center in New York City. “The advantage of choosing Hunterdon Regional Cancer Center for treatment of breast cancer is that patients will be fully evaluated and provided with all the options that give them the best chance of successfully fighting their cancer with minimal side effects.” In addition to the latest treatment techniques for breast and other cancers, Hunterdon Regional Cancer Center has two full-time nurse coordinators available to assist patients as they attempt to navigate the often confusing world of healthcare. “Innovation and treatment advances are meaningless if you can’t find your way through the maze of diagnostic tests, second opinions and treatment options,” says Pamela Vlahakis, RN, Hunterdon Regional Cancer Center’s Breast Care Coordinator. “The role of the Care Coordinator here at Hunterdon Regional Cancer Center is to assist patients through the process from diagnosis to treatment in a timely fashion, ensuring that all their questions are answered and they are completely comfortable with the decisions that are made regarding their care.” For more information about Hunterdon Regional Cancer Center’s Breast Care Program or other cancer services, call toll-free at 1-888-788-1260

Brachytherapy - Prostate Seed Implants

History

Surgery (“radical prostatectomy”) has been the standard of care for prostate cancer for the last 50 years. Although effective, radical prostatectomies are invasive and not without complications.

Initial radioactive seed implantation was performed via “free-hand” technique. The results of this preliminary approach was hampered by suspect dose distribution in the prostate due to non uniform seed placement. In 1987, Dr. Blasko from Seattle described a reproducible system to implant radioactive Iodine seeds in the prostate. This Seattle system employs a rectal ultrasound probe to directly visualize the prostate and a plastic template placed on the patient’s perineum (region between the scrotum and the rectum). The template guides the placement of the needles which are loaded with radioactive seeds. This technique allows a reproducible,uniform dose distribution to the prostate.

Our radiation oncologists have been performing this procedure since 1997.

For Whom?

Prostate seed implantation is not for everyone. Treatment decisions are based on important prognostic factors:

1. Stage 2. Gleason grade 3. PSA level

Our physicians have adopted the Seattle group’s criteria for implant selection. An ideal candidate should have a PSA level <10, Gleason grade 6 or less, with non-palpable disease. The size of the prostate is also an important factor. As a general rule, patients with prostate glands >60cc are at increased risk for pelvic arch obstruction and poor dose distribution. Androgen deprivation (hormone therapy) can be used to shrink large prostates for several months to allow an optimal seed implant.

Patients who previously have had a transrectal resection of the prostate (TURP) for benign prostatic hypertrophy may not be ideal candidates for this implant procedure due to higher rates of urinary complications.

Procedure

The first step in the process is an outpatient consultation with a radiation oncologist. The radiation oncologist will advise on the implant option based on the patient’s PSA, Gleason score, tumor stage, and other factors.

The second step is a planning transrectal ultrasound (TRUS). A transducer (probe) is placed in the rectum and images of the prostate gland are obtained. Once the prostate is visualized, the radiation oncologist works with the radiation physicists to determine where the seeds should be placed. The seeds are “peripherally loaded” to minimize the dose to the centrally located urethra. This will minimize the risk of urinary side effects.

The third step is the implant procedure. This is performed in the operating room under either general or spinal anesthesia. Under transrectal ultrasound guidance, the prostate is implanted through the perineum with needles loaded with radioactive seeds. Fluoroscopy confirms the seed placement into prostate. Immediately after the procedure, the patient is monitored for several hours. Typically, the patient is discharged to home on the same day.

The outcome of implantation is highly operator dependent. As such, it is important for the radiation oncologist to be experienced and proficient with this procedure. The radiation oncologists of Hunterdon Regional Cancer Center are among the most experienced and have been instrumental in pioneering this treatment option. Results

The Northwest Tumor Institute have documented excellent 10 year follow up data. Their long-term outcome was comparable to external beam radiation therapy and surgery.

Side effects

A common misconception among prospective patients is that prostate implantation has fewer side effects than external beam radiation therapy. This indeed is a misconception. Nearly all patients suffer from some urethritis andrinary retention requiring a temporary catheter occurs in 5% of the patients.